Study to Assess the Utility of Cloze Test in Readability Assessment of Patient Information Leaflets in English and Indian Languages

Patient education is one of the major management strategies for curing or preventing the progression of many diseases. Patient Information Leaflets (PILs) are major patient counseling aids. Readability is an important issue of communication with PILs and there is a need to assess the readability of tools prepared in Indian languages. Patient Information Leaflet for tuberculosis was prepared in English language. The prepared leaflets were then translated to Malayalam and Kannada. Cloze test was identified as a possible test for assessing readability of leaflets in English, Kannada and Malayalam. Cloze test was performed in 16 volunteers for each language. Layout and design of the leaflet was assessed using BALD assessment. The results showed that an increase in scores with increasing length of regularly deleted words in Cloze test. Kannada leaflets were found to be easier with increasing regularly deleted words whereas in Malayalam sixth word removal did not improve scores. Volunteers participated in Cloze test for all versions of leaflets, scored above 60%, which is considered to be readable and understandable by readers. BALD assessment score for the designed PILs for English, Malayalam and Kannada were 30, 27 and 28 respectively. Cloze test was able to discriminate between tough and easier versions of leaflet irrespective of the language. It can be concluded that the cloze test might be useful in assessing the readability of Indian language leaflets. BALD scores were assessed for all the prepared leaflets and showed that all of them had better score.